ROLE OF MULTIPARAMETRIC MRI IN THE EARLY DETECTION AND STAGING OF PROSTATE CANCER

Abstract

Systematic transrectal ultrasound-guided biopsy is a conventional technique of prostate cancer diagnosis, which has been associated with overdiagnosis of insignificant disease, and underdiagnosis of clinically significant prostate cancer (csPCA). The use of multiparametric magnetic resonance imaging (mpMRI) is a relatively new tool and in most of the practice fields, there is no quantitative comparison of diagnostic and clinical utility of the tool.This retrospective cohort study was a comparison between 1,247 men who either had mpMRI-targeted biopsy or systematic biopsy.. Measures of diagnostic accuracy, PI-RADS-stratified rates of detection, histopathological concordance, core efficiency, quantitative imaging biomarkers, reclassification of risk, cost- effectiveness and performance based on subgroups were compared. Multivariate logistic regression helped to estimate which independent predictors of csPCa. There was an exponential increase in sensitivity of the mpMRI-targeted biopsy and negative predictive value in comparison to the systematic biopsy with a 50.0% core efficiency to 18.9% to the system versus a 67-core reduction in cores. The systematic biopsy detection rates of 35.2 and 46.7 respectively of PI-RADS 4 and PI-RADS 5 lesions respectively respectively was also targeted at PI-RADS 4 and PI-RADS 5 lesions respectively respectively with the rate of 68.3 and 89.1 respectively. The negative predictive value of 92.4% enabled to avoid the biopsy in 24.1% of the patients. The values of ADC were much lower in the case of the Gleason Grade Group and mpMRI-targeted biopsies were assigned much lower values of ADC over all the grades. PI-RADS score (odds ratio: 4.82) and PSA density (odds ratio: 1.34 per 0.01 ng/mL²) were the strongest independent predictors of csPCa. The mpMRI-targeted pathway reduced the detection of ciPCa by 9.7 and the net reclassification value of +0.214 and it seems to be a cost effective strategy with a cost of 12,341 per quality-adjusted life-year benefit. All clinical subgroups and highest percentage of the decrease in the relative risks were similar in benefits and maximum benefits were registered in the past among the adverse biopsies patients. mpMRI-guided biopsy significantly improves the diagnoses accuracy, decreases overdiagnosis, offers better histopathological concordance and better risk sorts to systematic biopsy. These results justify the implementation of mpMRI as the main triage tool in the diagnosis of prostate cancer and make more accurate, cost-effective and patient-centered care and directly alleviate the drawbacks of the traditional biopsy paths.